Thank you for your interest in The Northeast PHO. The first step in joining our network of physicians is to request NECoMG membership. To ensure a smooth enrollment process and to minimize potential delays with insurance credentialing, the PHO recommends that you request NECoMG membership at the same time that Beverly Hospital privileges are being requested.
If a provider does not already hold Beverly Hospital privileges and has not already requested a privileging application, please reach out to Beverly Hospital Medical Staff Office (MSO) to request an application.
From the PHO perspective, the Provider Relations Department will need the following items to bring a new provider to a monthly NECoMG Board meeting for approval to become a Northeast PHO member and link to our health plan contracts:
- Managed Care Participation Application
- Copy of Provider’s CAQH Summary Page – For step-by-step Instructions, follow this link: https://www.nepho.org/wp-content/uploads/2023/11/How-to-pull-a-copy-of-a-CAQH-data-summary-BOTH-LOGOS.pdf
- Confirmation that Beverly Hospital privilege application is in process
- Copy of CV in Month/Year format
- Completed Health Plan Participation Form
- Collaborative Agreement (for Advanced Practitioners Only)
- Board Eligibility Letter (if provider is not yet Board Certified, or going through recert.)
- Copy of Malpractice Liability Insurance (COI)
- Participating providers completion of the Care Retention, Ownership Interests and Release of Information (Beverly | Winchester LCUs)